Johns Hopkins doctors outline meningitis death

The rapid decline in health and ultimate death of a woman from fungal meningitis at Johns Hopkins Hospital after she'd received a tainted steroid injection was outlined by a team of Hopkins doctors in a medical journal article released online Thursday.

The article, published in the Annals of Internal Medicine, says a 51-year-old woman arrived at a local emergency room at the end of August with a headache "radiating" from the back of her head to her face. She'd received the steroid injection a week earlier. About 10 days after going to the emergency room, she was dead.

There have been 16 reported meningitis infections in Maryland, and one death, tied to the same tainted batch of steroids, which patients received through spinal injections to treat back pain. There have been more than 230 cases nationally. Thousands may have been injected, authorities have said.

Meningitis is an infection that inflames a person's meninges, the membranes that cover the brain and spinal cord. Fungal meningitis, which cannot travel from person to person, is extremely rare.

The woman discussed in the article had a history of pain — neck pain, headaches, fibromyalgia — but no history of immune compromise or trauma and was not taking any long-term medications, wrote Dr. Jennifer L. Lyons, the article's lead author.

After she was examined at the local emergency room, a few tests were conducted and the woman, who was not identified, was sent home.

She returned the next day, seeing double and with vertigo and nausea, among other symptoms. She was hospitalized, and doctors began running tests.

Early on in the outbreak — the numbers of confirmed cases linked to the injections have rapidly increased since — doctors did not know to look for fungal meningitis right away, the article says.

Two days later, her third at the hospital, the woman's speech became slurred and the left side of her face began to droop. More tests, and treatments, were tried, but her condition continued to deteriorate.

The following day, she was transferred to Johns Hopkins Hospital for more intensive medical treatment. The site of her injection showed inflammation and possible fluid collection.

On the 10th day of her hospitalization, the woman died. Her autopsy showed severe brain damage, the article says.

The same day, a test came back confirming the fungal meningitis, the article says.

The tainted medication has been linked to New England Compounding Center in Framingham, Mass. Vials were sent to 76 clinics in 23 states, including seven in Maryland. The company has since been shut down.

The number of people who have died in the fungal meningitis outbreak rose to 20 on Thursday.